Georgia school telemedicine clinics to access EHRs

Georgia Partnership for Telehealth which has telemedicine programs at about 60 schools in Georgia, [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/06/Georgia-Partnership-for-Telehealth.jpg” thumb_width=”150″ /]has joined the Georgia Health Information Network, the state-wide Health Information Exchange, according to a recent press release. This will enable participating schools to securely exchange healthcare information with more than 3600 Georgia healthcare providers and have access to an immunisation register.
“Our Rural School-Based Telehealth Center Initiative offers a number of benefits to students and families,” Sherrie Williams, Executive Director of GPT is quoted as saying.  “Students receive quality care without having to miss class.  Parents don’t have to leave work and lose wages to take their child to see the doctor. If a specialist visit is needed, it doesn’t require hours in the car to reach a large healthcare center; the child can be examined right from the school clinic.”

What’s news at the end of the week

Care Innovations harmonizes seniors, Panasonic adds diabetes, Jawbone and Fitbit bite, the first EHR/PHR Hack and Concussion in Cleveland. Converging its interests in remote patient monitoring with its long-time footprint in senior housing resident monitoring (QuietCare), Intel-GE Care Innovations is testing its Health Harmony remote patient monitoring system, partnering with two California-located Front Porch communities and the Front Porch Center for Innovation and Wellbeing. The residents selected have poor chronic condition management or have returned after a discharge from a skilled nursing facility. No disclosure on projected number or duration–and it doesn’t appear that QuietCare is part of the monitoring. Release….Panasonic just bought Bayer Healthcare’s diabetes/blood glucose monitoring device unit for $1.13 billion as Bayer continues to shed non-life science businesses. While old-school prick-and-bleed monitors are being eclipsed by continuous glucose monitors (CGMs) and mobile-based devices such as Telcare in the US and in Europe, there’s plenty of market remaining in the West, and new ones in Asia and the Middle East for simple devices. It joins Panasonic’s existing blood pressure monitors. MedCityNews….Jawbone and Fitbit continue to snap at each other in court, with the former on Wednesday filing a second lawsuit on patent infringement, specifically “a wellness application using data from a data-capable band”, with the added fillip of going to the International Trade Commission, which could ban the import of Fitbit products or component parts. The 28 May lawsuit was about Fitbit’s hiring of five former Jawbone employees who allegedly stole IP. The companies between them have hundreds of patents, and as this Editor has noted in previous IP and patent troll articles, the US Patent and Trademark Office (USPTO) is not especially rigorous in ensuring that patents are not overbroad. Wonderful for the IP attorneys, but not exactly what Fitbit wants as a runup to their expected IPO next week. Wall Street Journal….Now an EHR and PHR join Hackermania Running Wild. Medical Informatics Engineering reported Tuesday that in May their server was cyberattacked, exposing PHI of patients in five clients and separately information contained in the NoMoreClipboard PHR subsidiary. POLITICO reports that this is the first recorded instance of an EHR compromise. MIE ReleasePOLITICO Morning eHealth….If you are in the Cleveland, Ohio area and have an interest, Concussion: A National Challenge is a free, two-day event on detection and diagnosis sponsored by the National Academy of Engineering, the Institute of Medicine, Case Western Reserve University, Metro Health and Taipei Medical University. Advance registration required.

Weekend Must Read: How an EHR in a teaching hospital gave a patient a 39X overdose

Weekend reading and a banquet for your consideration.

Though computers can and do improve patient safety in many ways, the case of Pablo Garcia vividly illustrates that, even in one of the world’s best hospitals, filled with well-trained, careful and caring doctors, nurses and pharmacists, technology can cause breathtaking errors.

This one began when a young physician went to an electronic health record and set a process in motion that never could have happened in the age of paper.

From The Overdose: Harm in a Wired Hospital by Robert Wachter, MD (Medium.com Backchannel), Part 1 of 4

The situation is a pediatric patient with a severe chronic illness, with multiple symptoms requiring multiple medications to control, admitted to University of California San Francisco (UCSF). The article is a case history of the chain of events, both technological and human, that led to an severe overdose of a routine antibiotic medication, which the patient had already been maintained on for years, nearly killing the child. You will see, with horror, how every check-and-balance failed in the prescribing and dispensing procedure, and why.

Dr Wachter is not only chief of the medical service and chief (more…)

HIMSS’ last full day highlights company partnerships

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/04/himss_chicago_2015-588×337.jpg” thumb_width=”150″ /]It’s almost time to Say Goodbye to Sinatra’s ‘My Kind of Town’, but there’s still news: Samsung+Partners Healthcare, IMS Health, AliveCor, Interoperability≠Humana, Panasonic+Cisco

  • Samsung and Partners HealthCare announced a direct-to-mobile partnership to develop chronic care management mobile software that monitors vital signs such as blood pressure, blood glucose and weight, as well as delivers mobile patient engagement, medication adherence and wellness self-management. Clinical trial is scheduled for June. Partners has always been a pioneer in the mHealth area, but playing with Samsung, Partners is flying at a slightly higher level than with Wellocracy and certainly the late Healthrageous. Partners release, Mobihealthnews (more…)

GE moving out of the hospital EHR business–and healthcare lending?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/04/2000px-General_Electric_logo.svg_.png” thumb_width=”100″ /]Updated. Spring cleaning at GE continues that may affect healthcare more than EHRs. Neil Versel catches at HIMSS, if not an exclusive, close to it, by finally getting a GE exec to admit the awful truth–that they are phasing out their Centricity Enterprise (hospital) EHR. Versel: “It’s now helping customers with a “graceful transition over a number of years,” said Jon Zimmerman, general manager of clinical business solutions at GE Healthcare.” Even more remarkable, that decision was made three years ago. MedCityNews also updated their article to highlight some of their recent problems with Intermountain Health; we’ve also noted that UCSF converted to Epic after 12 years (see our Weekend Must Read).

The GE Capital exit may affect healthcare too. The other and more major part of the spring cleaning–their exit from GE Capital with the sale/spinoff of assets over the next two years–was announced over the weekend (Bloomberg). Their Healthcare Financial Services lends to healthcare entities including hospitals, life science and in senior housing/health facilities. It also houses the Healthymagination Fund, the capital source for GE Ventures, its early stage developmental arm for healthcare, software and energy. According to The Wall Street Journal, GE will retain healthcare financing to support what it makes in its GE Healthcare unit: ultrasound, imaging, patient monitoring and diagnostics industrial equipment, down to the Vscan (yes! it’s still there). We would bet that GE Ventures is safe. But does this mean that its healthcare real estate unit within Healthcare Financial Services, which lends to senior housing, skilled nursing and other medical properties, is on the block, especially as GE this weekend completed the sale of its real estate holdings? What else, we wonder, will GE sell at the right price to pull up share price–and in the longer term, the future of its manufacturing in areas like major healthcare equipment which have been facing a declining and heavily competitive US market?

Exiting the hospital EHR business makes sense for GE, but what else will it entail? While it retained a solid footprint of vendor loyalty and satisfaction (more…)

30 ways mHealth is impacting healthcare–and EHRs need to be

If EHRs were perfect, there wouldn’t be so many companies developing communication workarounds. And why does a HIT consultant play Blame The Doctor?

Practice Unite, an early-stage company fresh out of Newark (cross the Hudson, head south) that knits together patient and clinician communications in highly customized app platforms for healthcare organizations [TTA 11 Mar], has put together a thought-provoking and fully attributed list of 30 ways mHealth is impacting healthcare: the value for patients and clinicians, the need for mHealth apps as part of collaborative care platforms and communication, plus the investment trail towards digital health. Hat tip to @PracticeUnite via Twitter.

One notable point is the difficulty current systems have in integrating data and the increased administrative load (+10 percent more) physicians experience with EHRs versus paper patient records. Confirming this are two items in Thursday’s POLITICO Morning eHealth: one, the privately-driven workaround for universal health data interoperability that the CommonWell Health Alliance is seeking as a non-profit trade alliance. and two, what happened when the GE Centricity EHR used by MedStar Health group’s DC and Baltimore-area outpatient clinics crashed after a weekend upgrade and stayed down through Tuesday night. Weekend data was lost. One doctor’s reaction:

“They kept saying it would be back up in an hour, but when I left work Tuesday night it was still down.” This doctor told us that the outage was “disruptive and liberating at the same time. I wrote prescriptions on a pad for two days instead of clicking 13 times to send an e-script. And I got to talk to my patients much more than I usually do. But of course we didn’t have access to any notes or medication history, and that was problematic.” 

Now this observation is neither petty nor isolated. Last Fall we noted a JAMA study of internal medicine physicians finding that for both experienced physicians and trainees, there was a loss of time across the board in taking notes, reviewing patient data and at least one data management function was s-l-o-w-e-r. [TTA 12 Sept 14] Houston, we have a problem.

Yet there are still the ‘nothing to see here, move along’ types sailing down A River in Egypt. Others blame the victims, as in the doctors, for their cloddish unwillingness to Get With The HIT Program. (more…)

EHRs: now safety, info exchange concerns (US, AU, CA)

What’s this? EHRs reducing, not increasing, safety? Reports from both the US and Australia seem to indicate another spanner (US: wrench) in the EHR works, aside from the laggardness in achieving the HITECH Act’s goals [TTA 27 Mar].

  • The Joint Commission, which is the chief US accreditation and certification body for healthcare organizations and programs, and thus to be taken very VERY seriously, released a Sentinel Event (Patient Safety Event) Alert yesterday. It warned of EHR-related adverse events affecting patient health, resulting from incorrect or miscommunicated information entered into EHRs. Interfaces built into the technology can contribute and studies have documented mixed results in the systems’ ability to detect and prevent errors. It identifies eight key factors,led by human-computer interface, workflow and communication and clinical content, that can lead to a sentinel event and three major remedy actions. While the JC does take pains to confirm the positive effects of well-designed and appropriately used EHRs, with strong clinical processes in place, it is the first ‘red flag’ this Editor can recall (more…)

Another go at a joint DOD-VA EHR? (US)

As this Editor was Pondering the Squandering last week of $28 billion HITECH Act funds meant to achieve EHR interoperability but falling well short, we recalled another Big EHR Squander: the integration of the Department of Defense’s (DOD) AHLTA with the Veteran Affairs’ VistA, an iEHR effort which collapsed in February 2013 at a mere $1 billion, in addition to dysfunctional or failed upgrades in both systems at just under $4 billion [TTA 27 July 13]. For civilians, this may not sound like much for concern, but for active duty, Reserve and National Guard service members transitioning from active to civilian status (and back as they are activated), often with complicated medical histories, it means a great deal.

At least one Congressman who also happens to be a physician, Representative Phil Roe, MD (R-TN) wants to try, try again. According to Politico’s Morning eHealth of last Wednesday, his bill will offer “a $50 million prize to the creator of an integrated military-veteran medical records system.” plus another $25 million over five years to operate it. DOD is moving forward with an $11 billion bid for a new EHR, but Rep. Roe’s staff issued a statement that differs with the DOD’s–that the new EHR still has no provision for secure and relatively seamless interoperability with the VA system to streamline the transfer of claims. We wish the best to Rep. Roe, and hope he can overcome Congressional inertia and two huge bureaucracies amidst doubts on the DOD’s EHR award process. FierceEMR on Roe bill, award process and adoption concerns by GAO and others. Also Anne Zieger in Healthcare Dive, iHealthBeat.

Pondering the squandering redux: $28 billion gone out the HITECH window

In 2009, the US Congress enacted the HITECH Act, as part of a much broader recovery measure (ARRA or ‘the stimulus’), authorizing the Department of Health and Human Services (HHS) to spend up to $35 billion to expand health IT and create a network of interoperable EHRs. Key to this goal of interoperability and seamless sharing of patient information among healthcare providers was achieving stages of ‘meaningful use’ (MU) with these EHRs in practice, to achieve the oft-cited ‘Triple Aim‘ of improved population health, better individual care, delivered at lower per capita cost. Financial incentives through Medicaid and Medicare EHR programs were delivered through multiple stages of MU benchmarks for hospitals and practices in implementing EHRs, information exchange, e-prescribing, converting patient records, security, patient communication and access (PHRs).

Five years on, $28 billion of that $35 billion has been spent–and real progress towards interoperability remains off in the distance. This Editor has previously noted the boomlet in workarounds for patient records like Syapse and OpenNotes. Yet even the progress made with state data exchanges (e.g. New York’s SHIN-NY) has come at a high cost–an estimated $500 million, yet only 25 percent are financially stable, according to a RAND December 2014 study. (more…)

EHRs can’t exchange patient records? $$ in workarounds.

Some of the Excedrin/Panadol Headaches (#11, #14, #23 and #54) in healthcare are around the very ‘miracle technology’ that was supposed to make it all seamless, non-duplicative, time/cost-effective and coast-to-coast–EHRs. The exchange of patient records between hospitals, within health systems between sites and with medical practices plus vice versa–works haltingly if at all. It works best within well-established, highly integrated delivery systems –the VA, DOD, Mayo Clinic, Kaiser, Geisinger, Intermountain Healthcare. But once you’re away from it–good luck. Where are the problems? The closed standards of the major hospital EHRs–Epic, Cerner, Allscripts, McKesson and brethren; the extreme customization most health systems demand (nay, a major Epic selling point!); structured versus unstructured data and how handled; a lack of a secure interoperability standard are but a few. Where is the gold? Getting patient health records exchanged, accessible and transportable, among systems that were essentially designed not to speak with each other. (more…)

Epic Systems getting into the app store business (US)

Epic Systems, the #1 company in the hospital and large practice EHR business, is launching its own app store, reportedly within a few weeks. This opens up interesting possibilities not only for mHealth app developers–who need application standards and guidelines soon–but also for Epic’s reputation as a closed system that shies away from interoperability with other EHRs like Cerner, Meditech and McKesson–a serious wrinkle with their Department of Defense EHR joint bid with IBM to replace AHLTA. The HIT Consultant article quotes a leading Epic customer consultant on that the first apps will be clinical, then crossing over into consumer; the latter seems an obvious move with PHRs (personal health records) as part of Meaningful Use requirements.

EHRs *do* take more time! (JAMA)

If your doctor or nurse is frustrated by their EHR, it’s not because they are a technophobe or klutzy on the keyboard. According to a research letter published in JAMA Internal Medicine (8 Sept), internal medicine physicians reported a loss of time of 48 minutes daily due to EHR use. 411 internal medicine attending physicians and trainees who worked in an ambulatory practice and used an EHR system responded to a 19-question survey in December 2012 by the American College of Physicians. The trainees reported a lower time loss–18 minutes. No conclusion is reached for this difference. Other findings indicated what took more time: (more…)

Electronic Alerts in EHRs Reduce Urinary Tract Infections (Study – US)

According to the World Health Organisation, urinary tract infections (UTIs) win top prize for most frequent health care-associated infection in high-income countries. And the cause?…A massive 75% of all of hospital acquired UTIs result from having a urinary catheter fitted (i.e. a tube inserted into the bladder through the urethra to drain urine). And it’s far from unusual to have this procedure done, for between 15 to 25 percent of hospitalized patients have one fitted during their hospital stay (Source CDC). Having a urinary tract infection can be nasty enough but if left untreated serious consequences can result including permanent kidney damage.

The most effective way to reduce the incidence of UTIs (apart from not having a catheter fitted in the first place) is by removing the catheter as soon as it is no longer needed. Unfortunately, all too often this does not happen. That’s why the findings from this new study from the University of Pennsylvania are significant. Results showed that automated alerts in Electronic Health Records (EHRs) reduced urinary tract infections in hospital patients with urinary catheters.

The EHR alert system worked by prompting physicians to specify the reason for inserting the patient’s catheter. On the basis of the reason selected, the system then helped them decide (a) whether urinary catheters were needed in the first place and (b) alerted them to reassess the need for catheters that had not been removed within a recommended time period. And it was no small-fry study. (more…)

Apple Health, minus the ‘book’, announced

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/06/healthkit-apple-wwdc-2014-87_verge_medium_landscape.jpg” thumb_width=”170″ /]Breaking and developing… Apple announced their long-rumored health tracking app [TTA 22 Mar] this morning at their WWDC (World Wide Developers Conference) in San Francisco. The consumer app is called Health (not Healthbook) and the developer platform HealthKit which are both part of iOS8 for iPhones and iPads in the fall. HealthKit facilitates pulling in of health data from third-party developers so that all health-related information for the consumer user is in one ‘hub’, similar to what Apple’s Passbook app does now as a ‘virtual pocket’ for airline boarding passes, movie tickets and coupons. Apple’s Craig Federighi, senior VP of software (pictured, courtesy of The Verge), made the announcement of the app and platform as part of the broader debut of iOS8 this morning.

Already on board is Mayo Clinic with an app that logs information like blood pressure, tracking normal range and it appears from reports that a severe enough deviation will initiate a contact with medical professionals. Nike was prominently featured as an app provider, further confirming that it’s leaving the hardware to their close corporate partner now that it’s out of the FuelBand business [TTA 22 April]. Epic Systems, a leading large system (hospitals/practices) EHR, appears to be integrating integrating its personal health record (PHR) with HealthKit, “suggesting a framework for getting information collected via HealthKit into patients’ MyChart (Epic PHR–Ed.) app.”

Editor Donna wonders if the still-in-early-days Better iPhone health personal assistant app (PHA), developed in conjunction with and backed by the aforementioned Mayo Clinic [TTA 23 Apr], will prominently integrate into Health. (We’ll cover when this develops, as we think it will–but mum’s their word for right now.)

In Mashable, the news was applauded by the CEO of leading app MyFitnessPal as a big validation. In his opinion, Apple would work with the existing field of apps and devices. Leading fitness bands Jawbone and Fitbit had no comment. Fitbit was shown during the presentation: CNET (one of six pictures here) and The Verge (article below). The latter makes the excellent point that Jawbone, Fitbit and the Nike FuelBand have all been sold in Apple’s stores.

The speculation is that Health will be a key part of the features of the iWatch to come, but Mashable in quoting Skip Snow of Forrester Research does bring up a significant wrinkle. Bluetooth LE as a network protocol chews up a lot of battery power, and bigger batteries make for clunky devices. Not exactly the Apple design ethic. Could it be that what’s delaying the iWatch is development of a new, more power-efficient network standard?

Update 3 June: With iOS8 having apps communicating with each other, have the Apple-oids opened the door for a Happy Hacking Holiday?  Stilgherrian in ZDNet points out that the ‘attack surface’ in info security-ese just got a whole lot larger. A future ‘oopsie’?

Hat tip to Editor Toni Bunting

More information: Mashable can’t stop mashing stories: Apple Reveals iOS 8: Interactive Notifications, Health App and MoreApple Gets Into Fitness Tracking With Health App and HealthKit for iOS 8Apple’s First Step Into Health Tracking Is Small But Powerful. Mobihealthnews gets into the act noting Epic’s involvement: Apple reveals tracking app HealthKit and partners with Mayo Clinic, Epic. The Verge positively is on said verge with Apple HealthKit announced: a hub for all your iOS fitness tracking needs.

Welsh Government to develop new eHealth and Care Strategy

The Government of Wales has announced that it is to develop a new eHealth and care strategy in [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/04/Welsh-Goverment.jpg” thumb_width=”150″ /]conjunction with health boards, NHS trusts and local authorities in Wales. The strategy will focus on using technology such as video conferencing, remote monitoring and better use of health records.

In a written statement issued last week while the Welsh Assembly is on its break, the minister for health and social services states that consultation will take place with health and social care professionals and users and the strategy will be in place by the end of the year.

“This will help us achieve our aim of ensuring there are more services, care and support available for patients in their homes or in their local communities” says the statement from Mark Drakeford.

“Technology has a key role to play. This could include the use of video conferencing to allow patients and health professionals to talk to each other; to aid diagnosis and decision making and remote monitoring for people with particular health conditions. Technology can also help improve access to services by bringing them closer to people’s homes, for example by providing mobile services in rural areas.

“With an increasing ageing population it is essential we enable people to live independently for as long as possible. Without this, the health and well-being of individuals will be adversely affected.

“We will expect our information to be accessible to professionals where and when it is needed whether in health or in social care. We already have the Individual Health Record, with appropriate security and governance in place. Any potential wider access to people’s data would only be with their consent.”

The full statement is available on the Welsh Government website here.